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Endometriosis HELP
Based on 7,482 articles published since 2008
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These are the 7482 published articles about Endometriosis that originated from Worldwide during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Guideline [First line management without IVF of infertility related to endometriosis: Result of medical therapy? Results of ovarian superovulation? Results of intrauterine insemination? CNGOF-HAS Endometriosis Guidelines]. 2018

Boujenah, J / Santulli, P / Mathieu-d'Argent, E / Decanter, C / Chauffour, C / Poncelet, P. ·Service de gynécologie-obstétrique, CHU Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France. Electronic address: jeremy.boujenah@gmail.com. · Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, Inserm U1016, université Paris-Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, 75005 Paris, France; GRC6-UPMC : centre expert en endométriose (C3E), hôpital Tenon, 75020 Paris, France. · Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 4308 gamétogenèse et qualité du gamète, CHRU de Lille, 59037 Lille cedex, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. · Service de gynécologie-obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 93022 Bobigny, France. ·Gynecol Obstet Fertil Senol · Pubmed #29551300.

ABSTRACT: INTRODUCTION: Using the structured methodology of French guidelines (HAS-CNGOF), the aim of this chapter was to formulate good practice points (GPP), in relation to optimal non-ART management of endometriosis related to infertility, based on the best available evidence in the literature. MATERIALS AND METHODS: This guideline was produced by a group of experts in the field including a thorough systematic search of the literature (from January 1980 to March 2017). Were included only women with endometriosis related to infertility. For each recommendation, a grade (A-D, where A is the highest quality) was assigned based on the strength of the supporting evidence. RESULTS: Management of endometriosis related to infertility should be multidisciplinary and take account into the pain, the global evaluation of infertile couple and the different phenotypes of endometriotic lesions (good practice point). Hormonal treatment for suppression of ovarian function should not prescribe to improve fertility (grade A). After laproscopy for endometriosis related to infertility, the Endometriosis Fertility Index should be used to counsel patients regarding duration of conventional treatments before undergoing ART (grade C). After laparoscopy surgery for infertile women with AFS/ASRM stage I/II endometriosis or superficial peritoneal endometriosis, controlled ovarian stimulation with or without intrauterine insemination could be used to enhance non-ART pregnancy rate (grade C). Gonadotrophins should be the first line therapy for the stimulation (grade B). The number of cycles before referring ART should not exceed up to 6 cycles (good practice point). No recommendation can be performed for non-ART management of deep infiltrating endometriosis or endometrioma, as suitable evidence is lacking. DISCUSSION AND CONCLUSION: Non-ART management is a possible option for the management of endometriosis related to infertility. Endometriosis Fertilty Index could be a useful tool for subsequent postoperative fertility management. Controlled ovarian stimulation can be proposed.

2 Guideline [Nerve sparing techniques in deep endometriosis surgery to prevent urinary or digestive functional disorders: Techniques and results: CNGOF-HAS Endometriosis Guidelines]. 2018

Rabischong, B / Botchorishvili, R / Bourdel, N / Curinier, S / Campagne-Loiseau, S / Pouly, J L / Canis, M. ·Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. Electronic address: brabischong@chu-clermontferrand.fr. · Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. ·Gynecol Obstet Fertil Senol · Pubmed #29551299.

ABSTRACT: OBJECTIVES: To evaluate the feasibility and functional urinary and digestive results of nerve sparing techniques in endometriosis surgery. METHODS: A research on the medline/pubmed database using specific keywords (nerve sparing, endometriosis, pelvic nerves) identified 7 publications among about 50 whose purpose was to describe the feasibility, the techniques and the functional results of nerve preservation in this indication. Among them there are: 2 uncontrolled retrospective studies, 3 prospective non-randomized studies, a meta-analysis and a review of the literature. RESULTS: Nerve preservation requires a perfect knowledge of the anatomy of the pelvic autonomic system. The laparoscopic approach is preferred by the different authors due to its anatomical advantage. The feasibility of this technique seems to be demonstrated despite certain limitations in the different studies and depending of the retroperitoneal extension of the lesions. When feasible, it is likely to significantly improve postoperative urinary function (urinary retention) compared to a conventional technique. It is observed no difference regarding digestive function. CONCLUSIONS: Nerve sparing in this indication is a technique the feasibility of which has been demonstrated and is subject to the topography and extent of the disease. In the absence of invasion or entrapment of pelvic autonomic nerves by endometriosis, this technique improves postoperative voiding function (NP3). During pelvic surgery for endometriosis, it is recommended to identify and preserve autonomic pelvic nerves whenever possible (GradeC).

3 Guideline [Management of endometriosis: CNGOF-HAS practice guidelines (short version)]. 2018

Collinet, P / Fritel, X / Revel-Delhom, C / Ballester, M / Bolze, P A / Borghese, B / Bornsztein, N / Boujenah, J / Bourdel, N / Brillac, T / Chabbert-Buffet, N / Chauffour, C / Clary, N / Cohen, J / Decanter, C / Denouël, A / Dubernard, G / Fauconnier, A / Fernandez, H / Gauthier, T / Golfier, F / Huchon, C / Legendre, G / Loriau, J / Mathieu-d'Argent, E / Merlot, B / Niro, J / Panel, P / Paparel, P / Philip, C A / Ploteau, S / Poncelet, C / Rabischong, B / Roman, H / Rubod, C / Santulli, P / Sauvan, M / Thomassin-Naggara, I / Torre, A / Wattier, J M / Yazbeck, C / Canis, M. ·Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France. Electronic address: pierre.collinet@chru-lille.fr. · Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France. · Haute Autorité de santé, 5, avenue du Stade-de-France, 93218 La Plaine-Saint-Denis cedex, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. · Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard-Lyon 1, 69000 Lyon, France. · Service de chirurgie gynécologie-obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, Inserm U1016, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France. · 29, rue de l'Essonne, 91000 Evry, France. · Service de gynécologie-obstétrique, CHU Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France. · 98, route de Blagnac, 31200 Toulouse, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 centre expert en endométriose (C3E), Sorbonne université, Paris, France; UMR-S938 Inserm Sorbonne université, Paris, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. · 3, rue Pablo-Picasso, 92160 Antony, France. · Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 4308 gamétogenèse et qualité du gamète, CHRU de Lille, 59037 Lille cedex, France. · EndoFrance, BP 50053, 01124 Montluel cedex, France. · Université Claude-Bernard-Lyon 1, 69000 Lyon, France; Clinique gynécologique et obstétricale, hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France. · Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France. · Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, équipe épidémiologie et évaluation des stratégies de prise en charge, VIH, reproduction, pédiatrie, université Paris-Sud, Paris, France. · Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87042 Limoges, France. · Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. · Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France. · Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris-Sud, 94276 Le Kremlin-Bicêtre cedex, France. · Service de chirurgie digestive, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, Paris, France; GRC6-UPMC, centre expert en endométriose (C3E), hôpital Tenon, Paris, France. · Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France. · Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France. · Service d'urologie, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 60495 Pierre-Bénite, France. · Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France. · Service de gynécologie-obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 93022 Bobigny, France. · Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France. · Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France. · Service d'imagerie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, Paris, France; Institut universitaire de cancérologie, Assistance publique, Paris, France. · Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France. · Centre d'étude et traitement de la douleur, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France. · Service de gynécologie-obstétrique, hôpital Foch, AP-HP, 40, rue Worth, 92151 Suresnes, France; Centre d'assistance médicale à la procréation, clinique Pierre-Cherest, 5, rue Pierre-Cherest, 92200 Neuilly-Sur-Seine, France. ·Gynecol Obstet Fertil Senol · Pubmed #29550339.

ABSTRACT: First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.

4 Guideline [Epidemiology and diagnosis strategy: CNGOF-HAS Endometriosis Guidelines]. 2018

Fauconnier, A / Borghese, B / Huchon, C / Thomassin-Naggara, I / Philip, C-A / Gauthier, T / Bourdel, N / Denouel, A / Torre, A / Collinet, P / Canis, M / Fritel, X. ·Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France. Electronic address: afauconnier@chi-poissy-st-germain.fr. · Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, Cancer, Inserm U1016, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France. · Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France. · Service d'imagerie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, institut universitaire de cancérologie, AP-HP, 21, rue de l'École-de-Médecine, 75006 Paris, Paris, France. · Clinique gynécologique et obstétricale, groupe hospitalier Nord-hôpital de la Croix-Rousse, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France. · Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87042 Limoges, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Encov-ISIT, UMR6284 CNRS, faculté de médecine, université d'Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France. · EndoFrance, BP 50053, 01124 Montluel cedex, France. · Centre Hospitalier Universitairede Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France. · Inserm CIC 1402, service de gynécologie-obstétrique et médecine de la reproduction, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France. ·Gynecol Obstet Fertil Senol · Pubmed #29548620.

ABSTRACT: Based on the best evidence available, we have provided guidelines for clinical practice to target the nature of endometriosis as a disease, the consequences of its natural history on management, and the clinical and imaging evaluation of the disease according to the level of care (primary care, specialized or referral). The frequency of endometriosis is unknown in the general population; endometriosis requires management when it causes symptoms (pain, infertility) or when it affect the function of an organ. In the absence of symptom, there is no need for follow-up or screening of the disease. Endometriosis may be responsible for various pain symptoms such as severe dysmenorrhea, deep dyspareunia, painful bowel movements or low urinary tract signs increasing with menstruation, or infertility. A careful evaluation of the symptoms and their impact on the quality of life should be made. The first-line examinations for the diagnosis of endometriosis are: digital examination and pelvic ultrasound. The second-line examinations are: the pelvic exam by an expert clinician, the pelvic MRI and/or the transvaginal ultrasound by an expert. MRI and ultrasound carrying different and complementary information. Other examinations may be considered as part of the pre-therapeutic assessment of the disease in case of specialized care. Diagnostic laparoscopy may be suggested in case of clinical suspicion of endometriosis whereas preoperative examinations have not proved the disease, it must be part of a management plan of endometriosis-related pain or infertility. During management, it is recommended to give comprehensive information on the different therapeutic alternatives, the benefits and risks expected from each treatment, the risk of recurrence, fertility, especially before surgery. The information must be personalized and take into account the expectations and preferences of the patient, and accompanied by an information notice given to the patient.

5 Guideline [Deeply infiltrating endometriosis and infertility: CNGOF-HAS Endometriosis Guidelines]. 2018

Mathieu d'Argent, E / Cohen, J / Chauffour, C / Pouly, J L / Boujenah, J / Poncelet, C / Decanter, C / Santulli, P. ·Service de gynécologie obstétrique et médecine de la reproduction, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: emmanuelle.mathieu@aphp.fr. · Service de gynécologie obstétrique et médecine de la reproduction, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. · Service de gynécologie obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. · Service de gynécologie obstétrique, CHU de Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France. · Service de gynécologie obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; UFR SMBH, université Paris 13, Sorbonne Paris-Cité, 93022 Bobigny, France. · EA 4308 Gamétogenèse et qualité du gamète, service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France. · Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU de Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U1016, équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, université Paris-Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France. ·Gynecol Obstet Fertil Senol · Pubmed #29544710.

ABSTRACT: Deeply infiltrating endometriosis is a severe form of the disease, defined by endometriotic tissue peritoneal infiltration. The disease may involve the rectovaginal septum, uterosacral ligaments, digestive tract or bladder. Deeply infiltrating endometriosis is responsible for disabling pain and infertility. The purpose of these recommendations is to answer the following question: in case of deeply infiltrating endometriosis associated infertility, what is the best therapeutic strategy? First-line surgery and then in vitro fertilization (IVF) in case of persistent infertility or first-line IVF, without surgery? After exhaustive literature analysis, we suggest the following recommendations: studies focusing on spontaneous fertility of infertile patients with deeply infiltrating endometriosis found spontaneous pregnancy rates about 10%. Treatment should be considered in infertile women with deeply infiltrating endometriosis when they wish to conceive. First-line IVF is a good option in case of no operated deeply infiltrating endometriosis associated infertility. Pregnancy rates (spontaneous and following assisted reproductive techniques) after surgery (deep lesions without colorectal involvement) varie from 40 to 85%. After colorectal endometriosis resection, pregnancy rates vary from 47 to 59%. The studies comparing the pregnancy rates after IVF, whether or not preceded by surgery, are contradictory and do not allow, to date, to conclude on the interest of any surgical management of deep lesions before IVF. In case of alteration of ovarian reserve parameters (age, AMH, antral follicle count), there is no argument to recommend first-line surgery or IVF. The study of the literature does not identify any prognostic factors, allowing to chose between surgical management or IVF. The use of IVF in the indication "deep infiltrating endometriosis" allows satisfactory pregnancy rates without significant risk, regarding disease progression or oocyte retrieval procedure morbidity.

6 Guideline [Performances and place of sonography in the diagnostic of endometriosis: CNGOF-HAS Endometriosis Guidelines]. 2018

Philip, C-A / Dubernard, G. ·Service de Gynécologie-Obstétrique, CHU Lyon Croix-Rousse, Hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France; Université Claude-Bernard - Lyon 1, 69000 Lyon, France. ·Gynecol Obstet Fertil Senol · Pubmed #29544709.

ABSTRACT: Endometriosis is difficult to diagnose clinically. Transvaginal sonography (TVS) is a procedure that is known to be operator-dependent, which mean that published evidences has to be balanced with the level of the sonographer that produced the data. The objective of this publication was to assess the performances of the sonography in the diagnosis of endometriosis in order to establish the French national recommendations. We searched the MEDLINE database for publication from January 2000 to September 2017 using keywords associated with endometriosis and sonography. Eighty-four trial and reviews published in English or French were included. Ovarian endometrioma can usually be diagnosed by a non-expert sonographer, especially when its aspect is typical. In case of an ovarian cyst with atypical presentation, it is recommended to control the sonography by a referent or to perform an MRI. In menopaused women, any ovarian cyst should be considered as a cancer until proven otherwise. In the diagnosis of posterior deep invasive endometriosis (DIE), TVS with sensitivity and specificity of 96 and 99% respectively, seems at least equivalent if not superior to MRI. However, these performances are related to expert sonographers. To reach sufficient efficiency in posterior DIE, the estimated learning curve for a sonographer is 44 cases. When posterior DIE is suspected, we recommend proposing a TVS "performed by an expert" or a MRI "at least interpreted by an expert". In anterior DIE, TVS has a good specificity (100%), but its sensitivity is poor in the literature (64%). TVS is therefore not able to eliminate the diagnosis. However a renal ultrasound should be proposed each time a urinary endometriosis is confirmed, and should be considered whenever posterior DIE is diagnosed especially the lesion is superior to 3cm.

7 Guideline [Definition, description, clinicopathological features, pathogenesis and natural history of endometriosis: CNGOF-HAS Endometriosis Guidelines]. 2018

Borghese, B / Santulli, P / Marcellin, L / Chapron, C. ·Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France. Electronic address: bruno.borghese@aphp.fr. · Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France. · Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe stress oxydant, prolifération cellulaire et inflammation, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France. ·Gynecol Obstet Fertil Senol · Pubmed #29540335.

ABSTRACT: Endometriosis and adenomyosis are histologically defined. The frequency of endometriosis cannot be precisely estimated in the general population. Endometriosis is considered a disease when it causes pain and/or infertility. Endometriosis is a heterogeneous disease with three well-recognized subtypes that are often associated with each other: superficial endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). DIE is frequently multifocal and mainly affects the following structures: the uterosacral ligaments, the posterior vaginal cul-de-sac, the bladder, the ureters, and the digestive tract (rectum, recto-sigmoid junction, appendix). The role of menstrual reflux in the pathophysiology of endometriosis is major and explains the asymmetric distribution of lesions, which predominate in the posterior compartment of the pelvis and on the left (NP3). All factors favoring menstrual reflux increase the risk of endometriosis (early menarche, short cycles, AUB, etc.). Inflammation and biosteroid hormones synthesis are the main mechanisms favoring the implantation and the growth of the lesions. Pain associated with endometriosis can be explained by nociception, hyperalgia, and central sensitization, associated to varying degrees in a single patient. Typology of pain (dysmenorrhea, deep dyspareunia, digestive or urinary symptoms) is correlated with the location of the lesions. Infertility associated with endometriosis can be explained by several non-exclusive mechanisms: a pelvic factor (inflammation), disrupting natural fertilization; an ovarian factor, related to oocyte quality and/or quantity; a uterine factor disrupting implantation. The pelvic factor can be fixed by surgical excision of the lesions that improves the chance of natural conception (NP2). The uterine factor can be corrected by an ovulation-blocking treatment that improves the chances of getting pregnant by in vitro fertilization (NP2). The impact of endometrioma exeresis on the ovarian reserve (NP2) should be considered when a surgery is scheduled. Endometriosis is a multifactorial disease, resulting from combined action of genetic and environmental factors. The risk of developing endometriosis for a first-degree relative is five times higher than in the general population (NP2). Identification of genetic variants involved in the disease has no implication for clinical practice for the moment. The role of environmental factors, particularly endocrine disrupters, is plausible but not demonstrated. Literature review does not support the progression of endometriosis over time, either in terms of the volume or the number of the lesions (NP3). The risk of acute digestive occlusion or functional loss of a kidney in patients followed for endometriosis seems exceptional. These complications were revealing the disease in the majority of cases. IVF does not increase the intensity of pain associated with endometriosis (NP2). There is few data on the influence of pregnancy on the lesions, except the possibility of a decidualization of the lesions that may give them a suspicious aspect on imaging. The impact of endometriosis on pregnancy is debated. There is an epidemiological association between endometriosis and rare subtypes of ovarian cancer (endometrioid and clear cell carcinomas) (NP2). However, the relative risk is moderate (around 1.3) (NP2) and the causal relationship between endometriosis and ovarian cancer is not demonstrated so far. Considering the low incidence of endometriosis-associated ovarian cancer, there is no argument to propose a screening or a risk reducing strategy for the patients.

8 Guideline [Diagnostic performance of MR imaging, coloscan and MRI/CT enterography for the diagnosis of pelvic endometriosis: CNGOF-HAS Endometriosis Guidelines]. 2018

Thomassin-Naggara, I / Bendifallah, S / Rousset, P / Bazot, M / Ballester, M / Darai, E. ·Service d'imagerie, hôpital Tenon, institut universitaire de cancérologie, Sorbonne universités, UPMC université Paris 06, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: isabelle.thomassin@aphp.fr. · Service de gynecologie-obstétrique et médecine de la reproduction, institut universitaire de cancérologie, Sorbonne universités, UPMC université Paris 06, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. · Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. · Service d'imagerie, hôpital Tenon, institut universitaire de cancérologie, Sorbonne universités, UPMC université Paris 06, AP-HP, 4, rue de la Chine, 75020 Paris, France. · Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, 69000 Lyon, France; Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Inserm, UMR S 938, faculté de médecine Pierre-et Marie-Curie, Site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France. ·Gynecol Obstet Fertil Senol · Pubmed #29540333.

ABSTRACT: Diagnostic performance of MR imaging for the diagnosis of pelvic endometriosis are good. Even if some differences of performances exists according the location considered, the risk of misdiagnosis is lower than 10% for trained teams (NP2). The performance of pelvic MR imaging and surgery are quite similar to diagnose endometrioma (sensitivity and specificity>90%). A negative pelvic MR imaging allows to exclude deep pelvic endometriosis with a performance similar to surgery but a positive MR imaging is less accurate than surgery because of a high number of false positives (23%). Pelvic MR imaging is more sensitive and less specific than ultrasonography for the diagnosis of uterosacral ligament, vagina or recto vaginal septum (NP2). Pelvic ultrasonography is more sensitive than pelvic MR imaging for the diagnosis of colorectal location (NP3). Pelvic MR imaging is a reproducible technique for the diagnosis of pelvic endometriosis (NP3). Regarding, quality criteria of pelvic MR imaging, no data are enough to recommend a specific MR unit, digestive preparation, or a specific moment during the menstrual cycle to realize the examination. Vaginal and/or rectal opacification are options. Most of studies are based a protocol including 3D T2W and 3DT1W sequences. Gadolinium injection is useful to characterize a complex adnexal mass. In clinical routine, slices crossing the kidneys are useful to evaluate the presence of pyelo calic distension. ColoCT is an accurate technique to diagnose pelvic digestive endometriosis (rectosigmoide and iléocaecal) (NP3).

9 Guideline [Surgical management of deep endometriosis with colorectal involvement: CNGOF-HAS Endometriosis Guidelines]. 2018

Ballester, M / Roman, H. ·Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: marcos.ballester@aphp.fr. · Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France. ·Gynecol Obstet Fertil Senol · Pubmed #29534879.

ABSTRACT: Deep endometriosis with colorectal involvement is considered one of the most severe forms of the disease due to its impact on patients' quality of life and fertility but also by the difficulties encountered by the clinicians when proposing a therapeutic strategy. Although the literature is very rich, evidence based medicine remains poor explaining the great heterogeneity concerning the management of such patients. Surgery therefore remains a therapeutic option. It improves the intensity of gynecological, digestive and general symptoms and the quality of life. Concerning the surgical approach, it appears that laparoscopy should be the first option; the laparoscopic robot-assisted route can also be proposed. The techniques of rectal shaving, discoid resection and segmental resection are the three techniques used for surgical excision of colorectal endometriosis. The parameters taken into account for the use of either technique are: the surgeon's experience, the depth of infiltration of the lesion within the rectosigmoid wall, the lesion size and circumference, multifocality and the distance of the lesion from the anal margin. In the case of deep endometriosis with colorectal involvement, performing an incomplete surgery increases the rate of pain recurrence and decreases postoperative fertility. In case of surgery for colorectal endometriosis, pregnancy rates are similar to those obtained after ART in non-operated patients. Existing data are insufficient to formally recommend first line surgery or ART in infertile patients with colorectal endometriosis. The surgery for colorectal endometriosis exposes to a risk of postoperative complications and recurrence of which the patients should be informed preoperatively.

10 Guideline [Diagnosis accuracy of endoscopy (laparoscopy, hysteroscopy, fertiloscopy, cystoscopy, colonoscopy) in case of endometriosis: CNGOF-HAS Endometriosis Guidelines]. 2018

Tardieu, A / Sire, F / Gauthier, T. ·Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France. · Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87042 Limoges, France. Electronic address: tristan.gauthier@chu-limoges.fr. ·Gynecol Obstet Fertil Senol · Pubmed #29530560.

ABSTRACT: OBJECTIVE: To provide clinical practice guidelines from the French college of obstetrics and gynecology (CNGOF) with the Haute Autorité de santé (HAS), based on the best evidence available, concerning the diagnosis accuracy of endoscopy (laparoscopy, hysteroscopy, fertiloscopy, cystoscopy, colonoscopy) in case of endometriosis. MATERIAL AND METHODS: English and French review of literature about the diagnosis accuracy of endoscopy in case of endometriosis. RESULTS AND CONCLUSION: Laparoscopy is useful in case of suspected endometriosis in patients with symptoms or infertility when appropriate preoperative assessment is negative (grade C). Biopsies during diagnosis laparoscopy are recommended in case of typical or atypical lesions to confirm endometriosis (grade B). It is not recommended to perform fertiloscopy in case of suspected endometriosis (grade C). Hysteroscopy could be performed in case of suspected endometriosis and infertility to eliminate endometrial polyp or septate uterus (grade C). Colonoscopy is not recommended in case of suspected deep posterior endometriosis (grade C).

11 Guideline [Specific clinical signs suggestive of endometriosis (excluding adenomyosis) and questionnaires of symptoms, pain and quality of life: CNGOF-HAS Endometriosis Guidelines]. 2018

Huchon, C / Aubry, G / Ploteau, S / Fauconnier, A. ·Service de gynécologie & obstétrique, CHI Poissy-St-Germain-en-Laye, Université Versailles-Saint-Quentin en Yvelines, 10, rue du champ Gaillard, BP 3082, 78303 Poissy cedex, France. Electronic address: cyrillehuchon@yahoo.fr. · Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France. · Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France. · Service de gynécologie & obstétrique, CHI Poissy-St-Germain-en-Laye, Université Versailles-Saint-Quentin en Yvelines, 10, rue du champ Gaillard, BP 3082, 78303 Poissy cedex, France. ·Gynecol Obstet Fertil Senol · Pubmed #29530559.

ABSTRACT: In case of consultation for chronic pelvic pain or suspicion of endometriosis, it is recommended to evaluate the pain (intensity, resonance) and to search out the evocative and localizing symptoms of endometriosis (Grade B). The main symptoms suggestive of endometriosis are: severe dysmenorrhea (NP2), deep dyspareunia (NP2), painful defecation during menstruation (NP2), urinary tract symptoms during menstruation (NP2) and infertility (NP2). In patients with chronic pelvic pain, it is recommended to search deep infiltrating endometriosis in patients with painful defecation during menstruation or severe deep dyspareunia (Grade B). It is recommended to search symptoms suggestive of sensitization in painful patients with endometriosis (Grade B). When suggestive symptoms of endometriosis are present, a directed gynecological examination is recommended, where possible, including examination of the posterior vaginal cul-de-sac (Grade C). In assessing pain intensity or evaluating analgesic effectiveness of a treatment, it is recommended to use a scale to measure the intensity of pain (Grade A). In the management of symptomatic endometriosis, it is recommended to evaluate the quality of life (Grade C).

12 Guideline [New medical treatments for painful endometriosis: CNGOF-HAS Endometriosis Guidelines]. 2018

Legendre, G / Delbos, L / Hudon, E / Chabbert-Buffet, N / Geoffron, S / Sauvan, M / Fernandez, H / Bouet, P-E / Descamps, P. ·Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, UVSQ, université Paris-Saclay, université Paris Sud, 94807 Villejuif, France. Electronic address: guillaume.legendre@chu-angers.fr. · Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France. · Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université, centre de recherche Saint-Antoine, GRC-6 centre expert en endométriose (CE3), Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Est parisien-Tenon, 75020 Paris, France. · Service de gynécologie-obstétrique, Assistance publique-Hôpitaux de Paris, hôpital de Bicêtre, 94276 Le Kremlin Bicêtre cedex, France. ·Gynecol Obstet Fertil Senol · Pubmed #29530558.

ABSTRACT: OBJECTIVE: The objective of this work is to evaluate the place of new treatments in the management of endometriosis outside the context of infertility. METHODS: A review of the literature was conducted by consulting Medline data until July 2017. RESULTS: Dienogest is effective compared to placebo in short term (NP2) and long term (NP4) for the treatment of painful endometriosis. In comparison with GnRH agonists, dienogest is also effective in terms of decreased pain and improved quality of life in non-operated patients (NP2) as well as for recurrence of lesions and symptomatology postoperatively (NP2). Data on GnRH antagonists, selective progesterone receptor modulators as well as selective inhibitors (anti-TNF-α, matrix metalloprotease inhibitors, angiogenesis growth factor inhibitors) are insufficient to provide evidence of interest in clinical practice for the management of painful endometriosis (NP3). CONCLUSION: Dienogest is recommended as second-line therapy for the management of painful endometriosis (Grade B). Because of lack of evidence, aromatase inhibitors, elagolix, SERM, SPRM and anti-TNF-α are not recommended for the management of painful endometriosis (Grade C).

13 Guideline [Endometriosis medical treatment: Hormonal treatment for the management of pain and endometriotic lesions recurrence. CNGOF-HAS Endometriosis Guidelines]. 2018

Geoffron, S / Cohen, J / Sauvan, M / Legendre, G / Wattier, J M / Daraï, E / Fernandez, H / Chabbert-Buffet, N. ·Service de gynecologie-obstetrique et medecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. · Service de gynecologie-obstetrique et medecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 Centre expert en endométriose (C3E), UMR-S938 Inserm, Sorbonne université, 75012 Paris, France. · Service de gynecologie-obstetrique, CHU de Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France. · Service de gynecologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-INSERM, U1018, équipe 7, genre, sante sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France. · Centre d'étude et traitement de la douleur, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France. · Service de gynecologie-obstetrique, CHU de Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, équipe épidémiologie et évaluation des stratégies de prise en charge : VIH, reproduction, pédiatrie, université Paris Sud, 94800 Villejuif, France. · Service de gynecologie-obstetrique et medecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 Centre expert en endométriose (C3E), UMR-S938 Inserm, Sorbonne université, 75012 Paris, France. Electronic address: nathalie.chabbert-buffet@aphp.fr. ·Gynecol Obstet Fertil Senol · Pubmed #29530557.

ABSTRACT: The available literature, from 2006 to 2017, on hormonal treatment has been analysed as a contribution to the HAS-CNGOF task force for the treatment of endometriosis. Available data are heterogeneous and the general level of evidence is moderate. Hormonal treatment is usually offered as the primary option to women suffering from endometriosis. It cannot be used in women willing to conceive. In women who have not been operated, the first line of hormonal treatment includes combined oral contraceptives (COC) and the levonorgestrel-releasing intra uterine system (52mg LNG-IUS). As a second line, desogestrel progestin only pills, etonogestrel implants, GnRH analogs (GnRHa) with add back therapy and dienogest can be offered. Add back therapy should include estrogens to prevent bone loss and improve quality of life, it can be introduced before the third month of treatment to prevent side effects. The literature does not support preoperative hormonal treatment for the sole purpose of reducing complications or recurrence, or facilitating surgical procedures. After surgical treatment, hormonal treatment is recommended to prevent pain recurrence and improve quality of life. COCs or LNG IUS are recommended as a first line. To prevent recurrence of endometriomas COC is advised and maintained as long as tolerance is good in the absence of pregnancy plans. In case of dysmenorrhea, postoperative COC should be used in a continuous scheme. GnRHa are not recommended in the sole purpose of reducing endometrioma recurrence risk.

14 Guideline [Endometriosis and fertility preservation: CNGOF-HAS Endometriosis Guidelines]. 2018

Decanter, C / d'Argent, E M / Boujenah, J / Poncelet, C / Chauffour, C / Collinet, P / Santulli, P. ·Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène Avinée, 59037 Lille cedex, France; EA 4308 gamétogenèse et qualité du gamète, CHRU de Lille, 59037 Lille cedex, France. Electronic address: Christine.decanter@chru-lille.fr. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie, 75005 Paris 6, France; Hôpital Tenon, GRC6-UPMC: centre expert en endométriose (C3E), 75020 Paris, France. · Service de gynécologie-obstétrique, CHU Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France. · Service de gynécologie-obstétrique, CH Renée-Dubos, 6, avenue de l'Ile-de-France, 95300 Pontoise, France; Université Paris-13, Sorbonne-Paris-Cité, UFR-SMBH, 93022 Bobigny, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France. · Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétiques et physiopathologie de la reproduction, département développement, reproduction, cancer, Inserm U1016, université Paris-Descartes, Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France. ·Gynecol Obstet Fertil Senol · Pubmed #29530556.

ABSTRACT: Fertility preservation (FP) techniques are progressing rapidly these past few years thanks to the oocyte vitrification. Indication of FP techniques is now extended to non-oncological situation that may induce risk of premature ovarian failure. Ovarian endometriosis can lead to premature ovarian failure and further infertility due to the high risk of ovarian cysts recurrence and surgery. To date, there is no cohort study regarding FP and endometriosis as well as no recommendation. Our purpose is to review the arguments in favor of FP in this specific area and to elaborate strategies according to each clinical form.

15 Guideline [Interest of hysterectomy with or without bilateral oophorectomy in the surgical treatment of endometriosis: CNGOF-HAS Endometriosis Guidelines]. 2018

Niro, J / Panel, P. ·Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177 route de Versailles, 78157 cedex Le Chesnay, France. Electronic address: jniro@ch-versailles.fr. · Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177 route de Versailles, 78157 cedex Le Chesnay, France. ·Gynecol Obstet Fertil Senol · Pubmed #29530555.

ABSTRACT: OBJECTIVE: In women with symptomatic endometriosis and no desire for pregnancy, hysterectomy with or without bilateral oophorectomy is often presented as a definitive solution to their symptoms. Despite this radical treatment, it should be known that nearly 15% of these patients will have persistent pain. Thus the objective of this review was to determine the interest of total hysterectomy with or without bilateral oophorectomy for the treatment of deep endometriosis. METHOD: The research was conducted from the US National Library of Medicine's National Institutes of Health from the following keywords: endometriosis, hysterectomy, oophorectomy, ovariectomy, radical treatment. Only articles written in English have been selected. RESULTS AND RECOMMENDATIONS: Hysterectomy with or without bilateral oophorectomy, associated with endometriotic lesions exeresis could decrease the rate of recurrence and surgical reoperations compared to resection alone endometriosis lesions (NP4). In women with no desire for pregnancy, the benefit-risk balance of a hysterectomy, with or without bilateral oophorectomy, may be discussed in order to reduce the risk of recurrence of endometriotic disease (Expert Agreement). Taking into account the multiple adverse effects of early menopause on expectancy and quality of life (NP2), ovarian preservation should be discussed with the patient in case of hysterectomy for deep endometriosis (Expert Agreement). The use of menopausal hormone therapy (THM) does not appear to increase the symptoms of endometriosis after surgical castration (NP3). THM is not contraindicated in postmenopausal women with endometriosis (grade C).

16 Guideline [Expectations of women with endometriosis: What information to deliver? CNGOF-HAS Endometriosis Guidelines]. 2018

Denouel, A / Fauconnier, A / Torre, A. ·Association Endofrance, BP 50053, 01124 Montluel cedex, France; Direction de la recherche et de l'innovation, centre hospitalier universitaire de montpellier, 39, avenue Charles-Flahault, 34295 Montpellier cedex 5, France. · EA 7285 risques cliniques et sécurité en santé des femmes, service de gynécologie-obstétrique, université Versailles-Saint-Quentin-en-Yvelines, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France. · Service de gynécologie-obstétrique et médecine de la reproduction, hopital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France; Division of Child Health, Obstetrics & Gynaecology, Dept of Obstetrics and Gynaecology, School of Medicine, University of Nottingham, City Hospital, Hucknall Road, NG5 1PB Nottingham, Royaume-Uni. Electronic address: dr.antoine.torre@gmail.com. ·Gynecol Obstet Fertil Senol · Pubmed #29530554.

ABSTRACT: Women with endometriosis often say that the information doctors give them should be improved. Patient support groups can provide missing information but may lack objectivity, or reliability, and may even generate anxiety or even harm their health. Clear unbiased medical information is the ideal. New patients with endometriosis wish to be taken seriously by primary care physicians, and be referred quickly to a specialist without further unnecessary investigation or delay. The diagnosis of endometriosis should ideally be made quickly, and should clearly specify the nature of the disease, its evolution, and its consequences on quality of life, relationships, and fertility. When choosing a treatment, information should state the risks of each treatment, the risks of recurrence long term, and the therapeutic alternatives. These should include conventional medical treatment, lifestyle adaptation, or alternative therapies. In case of surgery, prior written information should be provided, the likely scar appearance, the short and long term consequences in terms of pain, postoperative recovery time and complication rates. Once the surgery is performed, the degree of endometriotic involvement and the treatment undertaken should be explained. At discharge, patients should be told the expected recovery time, and the consequences of the operation on daily life.

17 Guideline [Extragenital endometriosis: Parietal, thoracic, diaphragmatic and nervous lesions. CNGOF-HAS Endometriosis Guidelines]. 2018

Merlot, B / Ploteau, S / Abergel, A / Rubob, C / Hocke, C / Canis, M / Fritel, X / Roman, H / Collinet, P. ·Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France. Electronic address: merlotbenjamin@gmail.com. · Service de gynécologie-obstétrique et médecine de la reproduction, hôpital mère-enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France. · Médecine de la reproduction, clinique Jean-Villar, avenue Maryse-Bastié, 33520 Bruges, France. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France. · Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor-d'Aquitaine, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. · Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France. · Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France. ·Gynecol Obstet Fertil Senol · Pubmed #29530553.

ABSTRACT: According to some studies, extragenital endometriosis represents 5% of the localisations. Its prevalence seems to be underestimated. The extra pelvic localisation can make the diagnosis more difficult. Nevertheless, the recurrent and catamenial symptomatology can evoke this pathology. Surgery seems to be the unique efficient treatment for parietal lesions. Pain linked to nervous lesions (peripheric and sacral roots) seems to be underestimated and difficult to diagnose because of various localisations. Neurolysis seems to have encouraging results. Diaphragmatic lesions are often discovered either incidentally during laparoscopy, or by pulmonary symptomatology as recurrent catamenial pneumothorax or cyclic thoracic pain. Surgical treatment seems as well to be efficient.

18 Guideline [Strategies and surgical management of endometriosis: CNGOF-HAS Endometriosis Guidelines]. 2018

Roman, H / Ballester, M / Loriau, J / Canis, M / Bolze, P A / Niro, J / Ploteau, S / Rubod, C / Yazbeck, C / Collinet, P / Rabischong, B / Merlot, B / Fritel, X. ·Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France. Electronic address: horace.roman@gmail.com. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. · Service de chirurgie digestive, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75001 Paris, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri Dunant, 63000 Clermont-Ferrand, France. · Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon Sud, 165, chemin du Grand Revoyet, 69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, 69000 Lyon, France. · Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France. · Service de gynecologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France. · Service de gynécologie-obstétrique, hôpital Foch, AP-HP, 40, rue Worth, 92151 Suresnes, France; Centre d'assistance médicale à la procréation, clinique Pierre Cherest, 5, rue Pierre Cherest, 92200 Neuilly-Sur-Seine, France. · Service de gynécologie-obstétrique et médecine de la reproduction, inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France. ·Gynecol Obstet Fertil Senol · Pubmed #29526793.

ABSTRACT: The article presents French guidelines for surgical management of endometriosis. Surgical treatment is recommended for mild to moderate endometriosis, as it decreases pelvic painful complaints and increases the likelihood of postoperative conception in infertile patients (A). Surgery may be proposed in symptomatic patients with ovarian endometriomas which diameter exceeds 20mm. Cystectomy allows for better postoperative pregnancy rates when compared to ablation using bipolar current, as well as for lower recurrences rates when compared to ablation using bipolar current or CO

19 Guideline [Urinary tract involvement by endometriosis. Techniques and outcomes of surgical management: CNGOF-HAS Endometriosis Guidelines]. 2018

Bolze, P-A / Paparel, P / Golfier, F. ·Université Claude-Bernard Lyon 1, hôpitaux universitaires de Lyon, centre hospitalier Lyon-Sud, service de chirurgie gynécologique et oncologique - obstétrique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. Electronic address: pierre-adrien.bolze@chu-lyon.fr. · Université Claude-Bernard Lyon 1, hôpitaux universitaires de Lyon, centre hospitalier Lyon-Sud, service de chirurgie urologique, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite. · Université Claude-Bernard Lyon 1, hôpitaux universitaires de Lyon, centre hospitalier Lyon-Sud, service de chirurgie gynécologique et oncologique - obstétrique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. ·Gynecol Obstet Fertil Senol · Pubmed #29526792.

ABSTRACT: Urinary tract involvement by endometriosis is reported in 1% of endometriosis patients (NP3). Consequences range from pelvic pain for bladder localizations to silent kidney loss in case of chronic ureteral obstruction (NP3). The feasibility of laparoscopic management was widely proven (NP3) and may reduce hospital stay length (NP4). Radical surgery with partial cystectomy for bladder localizations was shown to significantly and durably reduce pain symptoms with low risk of a severe postoperative complications (NP3). Medical hormonal treatment also shows short-term reduction of pain symptoms (NP4). Transureteral resection of bladder endometriosis nodule is not recommended (grade C) because of a high postoperative recurrence rate (NP4). Given a high risk of silent kidney loss, it is recommended that patients with ureteral involvement by endometriosis are managed by a multidisciplinary team considering urinary and potential extra-urinary localizations of endometriosis (grade C). No recommendation can be made on which technique to prefer between conservative (ureterolysis) or radical surgical techniques or on benefit and length of ureteral stents in case of ureteral involvement. Surgical management of bladder and ureteral localizations of endometriosis do not seem to be associated with altered or improved postoperative fertility (NP4). Since late postoperative ureteral anastomosis stenosis were reported with silent kidney loss, repeated postoperative imaging monitoring is justified (expert opinion).

20 Guideline [Evidence-based ways of colorectal anastomotic complications prevention in the setting of digestive deep endometriosis resection: CNGOF-HAS Endometriosis Guidelines]. 2018

Loriau, J / Petit, E / Mephon, A / Angliviel, B / Sauvanet, E. ·Service de chirurgie digestive, GH Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France. Electronic address: jloriau@gmail.com. · Service d'imagerie, GH Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France. · Service de gynécologie, GH Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France. · Service de chirurgie digestive, GH Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France. ·Gynecol Obstet Fertil Senol · Pubmed #29525185.

ABSTRACT: Management of deep pelvic and digestive endometriosis can lead to colorectal resection and anastomosis. Colorectal anastomosis carries risks for dreaded infectious and functional morbidity. The aim of the study was to establish, regarding the published data, the role of the three most common used surgical techniques to prevent such complications: pelvic drainage, diverting stoma, epiplooplasty. Even if many studies and articles have focused on colorectal anastomotic leakage prevention in rectal cancer surgery data regarding this topic in the setting of endometriosis where lacking. Due to major differences between the two situations, patients, diseases the use of the conclusions from the literature have to be taken with caution. In 4 randomized controlled trials the usefulness of systematic postoperative pelvic drainage hasn't been demonstrated. As this practice is not systematically recommended in cancer surgery, its interest is not demonstrated after colorectal resection for endometriosis. There is a heavy existing literature supporting systematic diverting stoma creation after low colorectal anastomosis for rectal cancer. Keeping in mind the important differences between the two situations, the conclusions cannot be directly extrapolated. In endometriosis surgery after low rectal resection, stoma creation must be discussed and the patient must be informed and educated about this possibility. Even if widely used there is no data supporting the role of epiplooplasty in colorectal anastomotic complication prevention? The place for epiplooplasty in preventing rectovaginal fistula occurrence in case of concomitant resection hasn't been studied.

21 Guideline [Management by assisted reproductive technology in women with endometriosis: CNGOF-HAS Endometriosis Guidelines]. 2018

Chauffour, C / Pouly, J-L / Gremeau, A-S. ·Département de gynécologie-obstétrique et de reproduction humaine, CHU Estaing, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France. Electronic address: candicechauffour@gmail.com. · Département de gynécologie-obstétrique et de reproduction humaine, CHU Estaing, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France. ·Gynecol Obstet Fertil Senol · Pubmed #29523480.

ABSTRACT: Should the presence of endometriosis change the management of assisted reproductive technology? There is no difference in pregnancy rate after IVF between an agonist or antagonist protocol in patients with endometriosis, so the choice between one or the other of these protocols is free. But the review of the literature has shown an improvement in the chances of pregnancy in case of prolonged ovulation suppression before stimulation for IVF with a GnRH agonist analogue or with oral contraception, especially in cases of severe endometriosis. Endometriosis, regardless of the stage and type of lesions, would have no effect on the IVF results in terms of pregnancy rate and live birth rate, but with a lower number of oocytes collected, especially in cases of severe endometriosis. In a context of superficial endometriosis without pain and of infertility, surgical treatment of superficial endometriosis is not recommended just to increase the chances of pregnancy in IVF. Surgery may have a place in case of failure of IVF to improve the results of the ART. In case of recurrence of endometriosis, surgery is not better than IVF, a medico-surgical concertation is recommended. In addition, studies on ovulation stimulation for IVF do not show any aggravation of the symptoms associated with endometriosis lesions, or an acceleration of its progression, or an increase in the rate of recurrence of the disease.

22 Guideline [Management of painful endometriosis in adolescents: CNGOF-HAS Endometriosis Guidelines]. 2018

Sauvan, M / Chabbert-Buffet, N / Geoffron, S / Legendre, G / Wattier, J-M / Fernandez, H. ·Service de gynécologie-obstétrique, CHU de Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address: marine.sauvan@aphp.fr. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 Centre expert en endométriose (C3E), Sorbonne université, 75005 Paris, France; UMR-S938 Inserm Sorbonne université, 75005 Paris, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. · Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, Genre, santé sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France. · Centre d'étude et traitement de la douleur, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France. · Service de gynécologie-obstétrique, CHU de Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France; CESP-Inserm, U1018, équipe épidémiologie et évaluation des stratégies de prise en charge : VIH, reproduction, pédiatrie, université Paris Sud, 94276 Le Kremlin-Bicêtre cedex France. ·Gynecol Obstet Fertil Senol · Pubmed #29519595.

ABSTRACT: OBJECTIVE: To analyse the literature on the treatment of adolescent painful endometriosis. METHOD: This work is based on a Review of the literature between January 2006 and December 2017. The Medline (Pubmed) and Cochrane database were searched for meta-analyzes, randomized trials, literature reviews, controlled, not controlled and retrospective studies published on the subject. Studies concerning adolescent's dysmenorrhea without endometriosis were excluded. RESULTS: Study quality is heterogeneous. Dienogest and GnRH agonists (GnRHa) are the only treatments specifically evaluated for the treatment of adolescent endometriosis. They reduce the pain associated with endometriosis. Combined oral contraceptives have not been studied in the context of endometriosis but they are effective on dysmenorrhea. Add back therapy, containing estrogens improves bone mineral density and quality of life for young women treated with GnRHa. CONCLUSION: Medical treatment of endometriosis in adolescent is associated with risks related to the young age. The therapeutic strategy should take into account the adverse effects of each treatment.

23 Guideline [Diagnostic strategies for endometriosis: CNGOF-HAS Endometriosis Guidelines]. 2018

Bourdel, N / Chauvet, P / Canis, M. ·Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT (UMR6284 CNRS/université d'Auvergne), 28, place Henri-Dunant, 63000 Clermont-Ferrand, France. ·Gynecol Obstet Fertil Senol · Pubmed #29514767.

ABSTRACT: In this chapter we have examined the possibilities of screening endometriosis, both in the general population as well as in the target population. We then proposed decision trees, for primary and secondary care. Currently, there is not enough data in the literature to develop or organize a screening test for endometriosis. Screening for endometriosis is not recommended in the general population (level A). There is also no evidence to support systematic screening in a population with genetic risk factors (endometriosis in a relative), or with other clinical risk factors (increased menstrual volume, short cycles, early menarche) (level A). However, it is possible to propose a decision tree for the management of chronic pelvic pain symptoms (dysmenorrhea, dyspareunia, non-menstrual pelvic pain). The search for symptoms suggestive of endometriosis (intense dysmenorrhea [visual analogue scale >7/10, frequent abstention, resistance to level 1 analgesics], infertility) should be systematic. The search for localizing symptoms of deep endometriosis (deep dyspareunia, cyclic defecation pain, cyclic urinary signs) enables to orient the patient to second line evaluation. We propose a decision tree for second and third line evaluations, according to the suspicion and/or the discovery of deep lesions with specific locations, or the suspicion of superficial lesions.

24 Guideline [Medical treatment for the management of painful endometriosis without infertility: CNGOF-HAS Endometriosis Guidelines]. 2018

Sauvan, M / Chabbert-Buffet, N / Canis, M / Collinet, P / Fritel, X / Geoffron, S / Legendre, G / Wattier, J-M / Fernandez, H. ·Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général de Gaulle, 94275 Le Kremlin-Bicêtre, France. Electronic address: marine.sauvan@aphp.fr. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 centre expert en endométriose (C3E), Sorbonne université, 75005 Paris, France; UMR-S938 inserm Sorbonne université, 75005 Paris, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri Dunant, 63000 Clermont-Ferrand, France. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France. · Service de gynécologie-obstétrique et médecine de la reproduction, inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. · Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France. · Centre d'étude et traitement de la douleur, hôpital Claude Huriez, CHRU Lille, rue Michel Polonowski, 59000 Lille, France. · Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général de Gaulle, 94275 Le Kremlin-Bicêtre, France; CESP-inserm, U1018, équipe épidémiologie et évaluation des stratégies de prise en charge : VIH, reproduction, pédiatrie, université Paris Sud, 94270 Le Kremlin-Bicêtre, France. ·Gynecol Obstet Fertil Senol · Pubmed #29510966.

ABSTRACT: OBJECTIVE: To provide clinical practice guidelines for the management of painful endometriosis in women without infertility. METHODS: Systematic review of the literature literature since 2006, level of evidence rating, external proofreading and grading of the recommendation grade by an expert group according to HAS methodology. RESULTS: Combined hormonal contraceptives (COP) and the levonorgestrel-releasing intra-uterin system (LNG-IUS) are recommended as first-line hormonal therapies for the treatment of painful endometriosis (grade B). Second-line therapy relies on oral desogestrel microprogestative, etonogestrel-releasing implant, GnRH analogs (GnRHa) and dienogest (grade C). It is recommended to use add-back therapy containing estrogen in association with GnRHa (grade B). After endometriosis surgery, hormonal treatment relying on COP or LNG-IUS is recommended to prevent pain recurrence (grade B). COP is recommended to reduce the risk of endometrioma recurrence after surgery (grade B) but the prescription of GnRHa is not recommended (grade C). Continuous COP is recommended in case of dysmenorrhea (grade B). GnRHa is not recommended as first line endometriosis treatment for adolescent girl because of the risk of bone demineralization (grade B). The management of endometriosis-induced chronic pain requires an interdisciplinary evaluation. Physical therapies improving the quality of life such as yoga, relaxation or osteopathy can be proposed (expert agreement). Promising medical alternatives are currently under preclinical and clinical evaluation.

25 Guideline [Minimal and mild endometriosis: Impact of the laparoscopic surgery on pelvic pain and fertility. CNGOF-HAS Endometriosis Guidelines]. 2018

Ploteau, S / Merlot, B / Roman, H / Canis, M / Collinet, P / Fritel, X. ·Service de gynécologie-obstétrique et médecine de la reproduction, hôpital mère-enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France. Electronic address: stephane.ploteau@chu-nantes.fr. · Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 39000 Bordeaux, France. · Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charle-Nicolle, 1, rue de Germont, 76031 Rouen, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France. · Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France. ·Gynecol Obstet Fertil Senol · Pubmed #29510965.

ABSTRACT: Minimal and mild endometriosis (stage 1 and 2 AFSR) can lead to chronic pelvic pain and infertility but can also exist in asymptomatic patients. The prevalence of asymptomatic patients with minimal and mild endometriosis is not clear but typical endometriosis lesions are found in about 5 to 10% of asymptomatic women and more than 50% of painful and/or infertile women. Laparoscopic treatment of minimal and mild endometriotic lesions is justified in case of pelvic pain because their destruction decrease significatively the pain compared with diagnostic laparoscopy alone. In this context, ablation and excision give identical results in terms of pain reduction. Moreover, literature shows no interest in uterine nerve ablation in case of dysmenorrhea due to minimal and mild endometriosis. Then, it is recommended to treat these lesions during a laparoscopy realised as part of pelvic pain. On the other hand, it is not recommended to treat asymptomatic patients. With regard to treatment of minimal and mild endometriosis in infertile patients, only two studies can be selected and both show that laparoscopy with excision or ablation and ablation of adhesions is superior to diagnostic laparoscopy alone in terms of pregnancy rate. However, it is not recommended to treat these lesions when they are asymptomatic because there is no evidence that they can progress with symptomatic disease. There is no study assessing the interest to treat these lesions when they are found fortuitously. Adhesion barrier utilisation permits to reduce post-operative adhesions, however literature failed to demonstrate the clinical profit in terms of reduction of the risk of pain or infertility.

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